Recurrent miscarriage -there is hope

Author : Dr.Monica Sachdeva

Date : 18 Feb 2020

Recurrent miscarriage, there is always hope.

A positive pregnancy test once a lady misses her periods give birth to lots of hope and happiness. The whole family becomes excited about a welcoming future, and then miscarriage happens. Dreams are shattered, hope converts into despair, happiness converts into worries.

Suppose this episode of miscarriage occurs again and again in life, we can very well imagine the burden of emotional turmoil on the lady and her family.

Recurrent miscarriage is defined as two or more consecutive miscarriages is not a very common condition with an occurrence of less than 1%. But evaluation is very important if this problem is there.

Causes of recurrent miscarriage?

1.An incorrect number of chromosomes- Most common condition,60% prevalence.Has random occurrence but the frequency increases once the lady crosses 40 years of age.

2. A problem in the genetic makeup of one of the parent-Occurrence rate of 3%.One of the parents may have balanced translocation in their genetic structure. Because of this parent will not have any problem but may lead to miscarriages.

3. A problem in the uterus- Uterus is the place where the embryo grows. If there is any congenital deformity in uterus like septa, bicornuate bicollis there can be a problem. Incompetent cervix, adhesions and scarring of the uterus also can cause miscarriages.

4. Some medical disorders are also responsible for recurrent miscarriage like diabetes, thyroid, antiphospholipid antibody syndrome and polycystic ovarian syndrome.

5. Malefactors- Some recent data suggest that sperm DNA fragmentation can contribute to recurrent pregnancy loss. A semen analysis and a special sperm DNA fragmentation test can help determine if this is an issue.

Evaluation of recurrent miscarriages:-

Detailed medical history, pelvic examination and some more tests are necessary to diagnose the possible cause of recurrent miscarriage.

?     Karyotype– A mapping of chromosomes of both the partners used to diagnose genetic defects.

?     Vaginal ultrasound– A scan that uses high-frequency sound waves to detect abnormalities in and around the uterus, ovaries, and fallopian tubes.

?     Hysterosalpingogram– An X-ray procedure in which a special dye is inserted to evaluate the shape of the uterus and the patency of the fallopian tubes.

?     Saline Sonohysterogram– A procedure where sterile water is placed into the cavity of the uterus while performing a transvaginal ultrasound. This procedure is useful to look for endometrial cavity abnormalities such as polyps, fibroids, and scar tissue that may increase the risk of a miscarriage.

?     Hysteroscopy– a procedure in which a narrow fiberoptic scope inserted into the uterus to look inside the uterine cavity.

?     Blood hormone levels– Blood tests that reveal the levels of certain hormones in the blood, such as prolactin, thyroid-stimulating hormone, and progesterone.

?     Endometrial biopsy– a procedure in which a sample of the endometrial tissue is examined under a microscope to determine if there is an infection present preventing the pregnancy from progressing.

?     Glucose screening– A blood test used to diagnose diabetes mellitus which, if left uncontrolled increases the likelihood of miscarriage.

?     Antiphospholipid antibody testing- blood tests used to detect an immune system abnormality.

?     Ovarian reserve testing- Testing of egg quantity and quality may help determine if the age-related decline in ovarian function is contributing to pregnancy loss.

?     Sperm DNA fragmentation test– a test to determine if sperm quality and DNA fragmentation may be contributing to pregnancy loss.

Treatment of recurrent pregnancy loss

 If an underlying cause is identified, treat it first. Sometimes, despite a comprehensive medical evaluation, in some patients exact cause of recurrent pregnancy loss can not be identified. This can be frustrating, but treatment options are available to lower the risk of miscarriage. These options include:

?     Ovulation induction.

?     Progesterone therapy.

?     Low dose aspirin.

?     Injectable blood thinners.

?     Antibiotics for presumed chronic inflammation of the uterus.

?     In vitro fertilization.

?     Preimplantation Genetic Testing for Aneuploidy (PGT-A).

?     Intracytoplasmic sperm injection.

Someone rightly said," Everyone wants happiness no one wants pain, but there can never be a rainbow without little rain."The journey of women facing recurrent miscarriages can be frustrating and painful, but the destination indeed is very beautiful.